Annual Report of the Director 2018 Part 5: Conclusions


The commemoration this year of the 40th anniversary of the Alma-Ata Declaration provides an opportunity for accountability. Over these 40 years, much progress has been made. It is important to learn the lessons of Alma-Ata as we seek to confront the challenges of attaining the SDGs, especially SDG 3: “Ensure healthy lives and promote wellbeing for all at all ages.”  Some of these key lessons  are  that barriers to access must be systematically identified and removed; fragmentation and segmentation of health systems and services is a recipe for failure; social participation at the grassroots level is a prerequisite for success; national governments must lead and own the process towards universal health, in coordination with partners; “universal” means universal, with no excuses or half measures in providing all necessary health services to all people; and universal health cannot be attained without multisectoral policies, programs, and actions that address the social determinants of health.

In order to advance to the highest attainable standard of physical, mental, and social well-being, we must maintain the long-standing commitment that PAHO’s Member States and PASB have to the values and principles of PHC; the promotion of rights-based approaches to health; equitable national health development; and the concepts of participation and inclusion.

Pregnant woman of Chajul
Pregnant woman of Chajul at Health Care Center in Chajul

Though the priority public health issues for the Region of the Americas may appear to be constant—including health systems strengthening, prevention and control of communicable and noncommunicable diseases, and public health emergencies—they are evolving. As the years pass and the technical cooperation environment changes, informed by new developments and knowledge, so must there be evolution in the strategies, mechanisms, methodologies, and techniques used by PAHO’s Member States and the PASB to maintain and improve the health of the peoples of the Americas.

 Given the changing political landscapes in the countries and the subregions of the Americas, greater advocacy for UH and primary health care is needed to maintain the health gains achieved in the Region, manage emerging and reemerging issues, and advance the 2030 Sustainable Development Agenda, while maintaining PASB’s country focus and catalyzing exchanges among the Member States themselves.

The pursuit of equity in health demands strengthened social participation and community engagement. The involvement of civil society to enable a people-centered approach to health systems strengthening and implementation of the PHC approach, where people are partners in managing their own health and that of their community, is a critical component of progress to UH. In working toward health for all, especially for those in conditions of exclusion and vulnerability, PAHO’s partnerships must continue to include civil society organizations and other non-State actors, working within FENSA as mandated by the PAHO Member States.

The Governments of PAHO Member States remain responsible for the health and development of their people, countries, and territories. Government leadership and political will to strengthen the PHC approach and advance to UH are fundamental factors in the processes that aim to strengthen and transform health systems in the Region. The exercise of the stewardship function of the health authorities requires strengthening of their technical capacity to formulate and implement health policies, as well as to advocate for, and contribute to, the formulation and implementation of all public policies that promote and underpin UH. This technical capacity entails determination of the feasibility, viability, and legitimacy of the changes needed; analysis of health needs and social determinants of health; and identification of relevant interventions. To persuade and support Governments to embrace multisectoral and whole-of-society actions towards UH and equity, the PASB’s efforts must include advocacy and provision of evidence to enable sound decision-making; sharing of knowledge and lessons learned; and promotion of cooperation among countries.

Mechanisms, spaces, and accountability for social participation are essential tools in ensuring that the design and implementation of health policies is aligned with the people’s expectations and needs. The development of a people- and community-centered model of care enables the integration of people and civil society as key stakeholders in this process. This is an opportune time for innovative and creative strategies to enhance community and social participation, and to enable people to make optimal choices for their own health.

A key tenet of the PHC approach is the provision of comprehensive health services as close as possible to where people live and work. Effective service coverage and health outcomes can be greatly improved by strengthening the first level of care within an integrated health services delivery network that brings together health promotion, disease prevention, and a set of progressive health services; takes into consideration the specific social and health conditions of the population; and uses an intersectoral approach. Strategic investments in health financing that target the development of human resources for UH and improvement in health infrastructure are critical. So is the establishment of social insurance and social protection programs that allow people to access PHC and integrated health services when needed. Improved financial accessibility of PHC services is an essential component of progress to UH and reduction of health inequities.

The Region of the Americas has consistently participated and demonstrated leadership in global processes to define, renew, and strengthen the PHC approach. The Region will continue to do so at the Global Conference on PHC in October 2018 and beyond, by advocating for UH as a concept that includes both coverage of and access to quality, comprehensive, integrated health services and by sharing successful experiences that can contribute to the renewal of national, subregional, regional, and global commitments for PHC as a key strategy to achieve UH and the SDGs. PASB is dedicated to the values and principles of PHC as a strategy to transform health systems towards universal health. PASB’s regional leadership in the renewal of the commitment to PHC has made possible stronger alliances with Member States; with technical teams in the ministries of health, health services, and other sectors related to health; with academia; and with both organized and nonorganized civil society.

As concepts, strategies, mechanisms, and tools for attaining the desired state of universal health evolve, PAHO Member States and PASB, in alignment with WHO and other UN agencies, and in close collaboration with development partners, civil society, and the private sector—as appropriate—will continue to plan, implement, monitor, and evaluate strategies for countries to enhance primary health care, develop resilient health systems, and progress to universal health, thus advancing health and well-being and leaving no one behind.

List of acronyms and abbreviations

AECID: Spanish Agency for International Development Cooperation

AMR: antimicrobial resistance

CARPHA: Caribbean Public Health Agency

CARICOM: Caribbean Community

CCHD:  cooperation among countries for health development

CCS: Country Cooperation Strategy

CICOM:  Medical Information and Coordination Cell

COHSOD: Council for Human and Social Development (CARICOM)

COMISCA: Council of Ministers of Health of Central America

CRS: Caribbean Regulatory System

DFID: Department for International Development (United Kingdom)

EMTs:  emergency medical teams

EOC:  Emergency Operations Center

EWEC-LAC: Every Woman, Every Child – Latin America and the Caribbean

FAO:  Food and Agriculture Organization of the United Nations

FCTC: Framework Convention on Tobacco Control

FENSA: Framework of Engagement with Non-State Actors

GAC:  Global Affairs Canada

GDP:  gross domestic product

GPW 13: Thirteenth General Program of Work (World Health Organization)

HCC:  Healthy Caribbean Coalition

HiAP: Health in All Policies

HIV: human immunodeficiency virus

HRUH: human resources for universal health

IAEA:  International Atomic Energy Agency

IDB: Inter-American Development Bank

IDRC: International Development Research Center (Canada)

IHR: International Health Regulations (2005)

IHSDN: integrated health services delivery network

IHSLAC: Integrated Health Systems in Latin America and the Caribbean

IMCI: Integrated Management of Childhood Illnesses

IMF: International Monetary Fund

IMS: Incident Management System

IS4H:  information systems for health

LGBT: lesbian, gay, bisexual, and trans

mhGAP:  Mental Health Gap Action Program (World Health Organization)

NCDs:  noncommunicable diseases

NSAs: non-State actors

OFID: OPEC Fund for International Development

PAHO:  Pan American Health Organization

PASB: Pan American Sanitary Bureau

PASC: Pan American Sanitary Conference

PERC: Production, Efficiency, Resources and Costs

PHAC:  Public Health Agency of Canada

PHC:  primary health care

PMMHS: Productive Management Methodology for Health Services

SDG:  Sustainable Development Goal

SHAA2030 Sustainable Health Agenda for the Americas 2018-2030

SICA:  Central American Integration System

SIDS:  small island developing states

STIs: sexually transmitted infections

SUS: Unified Health System (Brazil)

TCIM: traditional, complementary, and integrative medicine

UH:  universal health

UHC:  universal health coverage

UNAIDS:  Joint United Nations Program on HIV/AIDS

UNDP:  United Nations Development Program

UNICEF:  United Nations Children’s Fund

UNFPA: United Nations Population Fund

UNGA: United Nations General Assembly

UN Women: United Nations Entity for Gender Equality and the Empowerment of Women

U.S. CDC: United States Centers for Disease Control and Prevention

VCPH:  Virtual Campus for Public Health

WB: World Bank

Acknowledgments of support

The Pan American Sanitary Bureau is grateful for the support of its Member States through their quota contributions, and for the generous voluntary contributions of governments, agencies, and institutions, including:

Alliance for Health Policy and Systems Research

Amazon Cooperation Treaty Organization


Andalusian Agency for International Development Cooperation

Andean Health Organization [ORAS-CONHU]

Anton de Kom University of Suriname

Autism Speaks

Axon Medical Technologies

Bernard van Leer Foundation

Bill & Melinda Gates Foundation

Binational Development Plan for the Peru-Ecuador Border Region, Peru chapter

Caribbean Community

Caribbean Community Climate Change Center

Caribbean Development Bank

Caribbean Law Institute Center

Caribbean Public Health Agency

CARICOM Regional Organization for Standards and Quality

Cayetano Heredia Peruvian University

CDC Foundation

Center for State Control of Drugs and Medical Devices (Cuba)

Central National Institute of Ablation and Implants (Argentina)

City of Buenos Aires

Climate and Clean Air Coalition

Costa Rican Social Security Fund

Council for International Organizations of Medical Sciences

Dalhousie University

Department of Foreign Affairs and Trade (Australia)

Department of Foreign Affairs, Trade and Development (Canada)

Direct Relief

District Health Fund – Bogota District Health Department

Durham University

Emory University

European Civil Protection and Humanitarian Aid Operations

European Commission

European Union

Federal University of Rio Grande do Sul

Federal University of Santa Catarina

Food and Agriculture Organization of the United Nations

Garrahan Foundation

Gavi, the Vaccine Alliance

Global Affairs Canada

Global Fund to Fight AIDS, Tuberculosis and Malaria

Good Neighbors Guatemala

Government of Australia

Government of Brazil

Government of Canada

Government of Chile

Government of Cuba

Government of Ecuador

Government of Haiti

Government of Luxembourg

Government of Nicaragua

Government of Norway

Government of Peru

Government of Spain

Government of Sweden

Government of the Republic of Korea

Government of Trinidad and Tobago

Healthy Caribbean Coalition

Hemispheric Program for the Eradication of Foot-and-Mouth Disease

Humber River Hospital

India, Brazil and South Africa Fund

Inter-American Development Bank

InterAmerican Heart Foundation

Inter-American Institute for Cooperation on Agriculture

Inter-American Network of Food Analysis Laboratories

Inter-American Society of Cardiology

International Agency for the Prevention of Blindness

International Agency for Research on Cancer

International Atomic Energy Agency

International Bank for Reconstruction and Development

International Business Machines Corporation

International Development Research Center

International Medical Corps

International Monetary Fund

International Organization for Migration

International Regional Organization for Plant and Animal Health

Italian Hospital of Buenos Aires

Japan International Cooperation Agency

Johns Hopkins University School of Nursing

Joint United Nations Program on HIV/AIDS

Korea International Cooperation Agency

Latin American Association of Pharmaceutical Industries

Latin American Federation of the Pharmaceutical Industry

Latin American Society of Hypertension

Luxembourg Ministry of Development Cooperation and Humanitarian Affairs

MacArthur Foundation

Ministry of Agriculture, Livestock, and Food Supply (Brazil)

Ministry of Agriculture, Livestock, Aquaculture, and Fisheries (Ecuador)

Ministry of Foreign Affairs and International Cooperation Office of Development Cooperation (Italy)

Ministry of Foreign Relations and Trade of New Zealand

Ministry of Foreign Relations of Chile

Ministry of Health and Sports of Bolivia

Ministry of Health, Labour and Welfare of Japan

Ministry of Health of Argentina

Ministry of Health of Brazil

Ministry of Health of Chile

Ministry of Health of Costa Rica

Ministry of Health of the Province of Entre Ríos (Argentina)

Ministry of Health of the Province of Mendoza (Argentina)

Ministry of Health of the Province of Santa Fe (Argentina)

Ministry of Health of the Province of Santiago del Estero (Argentina)

Ministry of Health of the Republic of Panama

Ministry of Health of the Republic of Peru

Ministry of Health of Trinidad and Tobago

Ministry of Public Health of Guyana

Ministry of Public Health and Social Assistance of Guatemala

Ministry of Public Health and Social Assistance of the Dominican Republic

Municipal Secretariat of Health of the City of São Paulo (Brazil)

National Autonomous University of Nicaragua

National Cancer Institute of Argentina

National Cancer Institute of Colombia

National Council of State Health Secretaries (Brazil)

National Drug Board (Uruguay)

National Health Agency (Brazil)

National Health Foundation (Brazil)

National Health Regulation, Control and Surveillance Agency (Ecuador)

National Health Surveillance Agency (Brazil)

National Institute of Food and Drug Surveillance (Colombia)

National Institute of Health of Colombia

National Institute of Health of El Salvador

National Institute of Public Health of Mexico

National Institute of Social Services for Retirees and Pensioners (Argentina)

National School of Public Health (Cuba)

National Service for Animal Health and Quality (Paraguay)

Netherlands Ministry of Foreign Affairs

Network of National Cancer Institutes of the Union of South American Nations


Norwegian Agency for Development Cooperation

Office of United States Foreign Disaster Assistance

OPEC Fund for International Development

Orbis International

Organization of Eastern Caribbean States

Organization of American States

OPEC Fund for International Development

Pan Caribbean Partnership against HIV/AIDS

Permanent Mission of Brazil to the OAS

Plan International

Population Services International

Program for Appropriate Technology in Health

Public Health Agency of Canada

Rosarino Center for Perinatal Studies

Royal Netherlands Army

Royal Netherlands Navy

RTI Health Solutions

Sabin Vaccine Institute

Secretariat of Health of Cundinamarca (Colombia)

Secretariat of Health of Honduras

Secretariat of Health of Mexico

Secretariat of Health of the State of Bahia (Brazil)

Secretariat of Health of the State of Maranhão (Brazil)

Secretariat of Health of the State of Pará (Brazil)

Secretariat of Health of the State of Pernambuco (Brazil)

Secretariat of Health of the State of Rio Grande do Sul (Brazil)

Secretariat of Health of the State of São Paulo (Brazil)

Secretariat of Health of the State of Tocantins (Brazil)

South American Council on Health

Spanish Agency for International Development Cooperation

Special Program for Research and Training in Tropical Diseases

Standards and Trade Development Facility

Sustainable Sciences Institute

Task Force for Global Health

Therapeutic Goods Administration (Department of Health of Australia)

Tobacco-Free Kids

Together for Girls

United Kingdom Department for International Development

United Kingdom Department of Health and Social Care

United Nations Central Emergency Response Fund

United Nations Children's Fund

United Nations Development Program

United Nations Entity for Gender Equality and the Empowerment of Women

United Nations Environment Program

United Nations Foundation

United Nations Fund for International Partnerships

United Nations Secretariat for the International Strategy for Disaster Reduction

United Nations Joint Global Program on Cervical Cancer Prevention and Control

United Nations Multi-Partner Trust Fund

United Nations Partnership to Promote the Rights of Persons with Disabilities

United Nations Population Fund

United Nations Trust Fund for Human Security

United States Agency for International Development

United States Department of Health and Human Services

United States Food and Drug Administration

United States-Mexico Border Health Commission

United States National Council on Urban Indian Health

University of Belize

University of Brasilia

University of Chile

University of Guyana

University of Illinois

University of the West Indies

U.S. Centers for Disease Control and Prevention

Vaccine Ambassadors

Vital Strategies

Wellcome Genome Campus

World Bank

World Diabetes Foundation

World Hypertension League

World Organization for Animal Health

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